The post I’m writing about the STATS.org breastfeeding article is getting so long that I’m splitting it into two parts. I’ll look at their use of data and statistical analysis in the second part, but first I wanted to discuss the view of breastfeeding Goldin, Smyth and Foulkes present at the beginning of their article.
They start out by stating that "the costs of nursing are substantial". If they had genuinely been out to present a fair and balanced viewpoint, a statement that the costs of nursing can be substantial for some women would have served that purpose much better. I struggled to nurse a baby with a tongue tie despite a sad lack of local facilities for the simple procedure that would have put things right, and then pumped regularly for eight months after my return to work; I know damn well that breastfeeding can sometimes be difficult. And my experience was a bed of roses compared to that of some women I know. But we’re the exception rather than the rule. For the majority of women, breastfeeding is actually a lot easier overall than formula feeding.
I say "overall" because the first few weeks can be difficult, and breastfeeding at this stage often is more difficult than formula feeding. However, by far the most common experience of women who can hang in there for long enough to get through the initial difficulties is that a few weeks down the line, breastfeeding becomes much easier than formula feeding, to the point where it’s well worth the initial investment of time and energy even from a purely practical point of view. The problems settle down, and you can enjoy not having to spend your time over the rest of the first year mixing formula or sterilising bottles. Of course it doesn’t always happen this way – sometimes the problems don’t settle, and sometimes they’re so severe in the first few weeks that a woman just can’t get past them (although these situations would happen far less frequently if all women had proper advice and support). But a sweeping statement that the costs of nursing are substantial is unwarranted scaremongering.
The article continues: "[T]he reduced time for work due to the need to pump, nurse, eat and sleep has a huge economic and social impact on women and their families." Pumping can certainly be a hassle, though it’s not necessarily as negative as they make out – as I said, I pumped at work for eight months, and neither my employers, my family nor my salary suffered as a result. I just rearranged my schedule to spend the pumping sessions on the paperwork and phone calls that would have had to be done in any case. It was boring and a nuisance, but it was doable. I know that this depends on the job and there are a lot of women for whom pumping at work just isn’t an option – but for a lot of others it’s perfectly feasible, and it’s a possibility of which I’d like to see more women aware. (Mixed feeding is also an option that should be mentioned much more frequently than it is – women who want to breastfeed but can’t/don’t want to pump at work can nearly always still nurse during the times they’re at home.)
But I’m a little confused as to how eating and sleeping ended up on a list of supposed disadvantages of nursing; if I hadn’t breastfed, would I somehow have been magically transformed into a superhuman who could eschew such frailties and work 24/7? I’m also not quite sure why nursing is supposed to take more of women’s time than formula feeding would (surely the reverse is more likely to be true?), unless the authors are trying to suggest that women shouldn’t feed their babies at all but should palm this task off entirely on others while they go and dedicate their time to earning money.
The article continues with a discussion of possible disadvantages of nursing which appears to owe more to a weakness for popular myth than to an attempt to present the facts in a reasonably balanced way. It is indeed possible that an unsuccessful attempt at nursing could worsen depression, but it’s also possible, given the anecdotal evidence of nursing triggering hormonal reactions that lead to relaxed euphoric feelings, that nursing could actually offer some protection against post-partum depression. (In the absence of prospective studies, we can only guess. That applies to STATS.org too.) Nursing can sometimes be painful, but something that is not nearly as widely known as it should be is that pain, far from being an inevitable part of nursing, is nearly always an indicator of a problem that can be straightforwardly solved. There are indeed sometimes medical reasons not to breastfeed, but there are also sometimes medical reasons not to exercise, and for some reason we don’t tend to see that disclaimer showing up in discussions of the overall health benefits of exercise.
CMV infection via breastmilk can affect premature babies, but a quick search through Medline shows that the currently available evidence doesn’t support this being a major problem, and STATS.org somehow failed to mention that the risk doesn’t seem to affect full-term babies. Drug addicts may well, depending on the drug, be better off not nursing, but I wouldn’t go so far as to call this conclusion obvious – I was told by one of the paediatric consultants I worked for that, apart from cocaine, no drugs are absolute contraindications to breastfeeding, and I know there’s a theory that it may actually help ease withdrawal symptoms in a neonate. Maternal smoking or drinking may affect breastfed babies, but don’t seem to do so at low levels. And while some mothers genuinely don’t have enough milk, it’s worth knowing that most of the mothers who think or have been told they don’t have enough actually could have with the proper advice.
Most of what the authors say is not, technically speaking, actually inaccurate. The problem is with the spin they put on it. They seem to be setting out to present breastfeeding in as unmitigatedly negative a way as they can.